The Omicron change in Europe: pandemic or endemic?

LONDON – In Britain, France, Spain and other countries in Europe, politicians and some public health experts are advocating a new approach to the coronavirus pandemic that is both bold and resigned: that illness is becoming an inescapable part of daily life.

Governments are seizing a moment when their populations have seen less severe disease and, in some cases, a drop in new daily cases after weeks of record growth. And they are moving their mitigation policies out of the state of emergency.

In Spain, for example, Prime Minister Pedro Sánchez said last week that citizens “should learn to live with it, as we do with many other viruses”, and said the country should adjust the national approach to align more closely with how it handles flu outbreaks. Olivier Véran, the French Minister of Health, said recently that the high level of infection and the high rate of vaccination in France could “maybe” mean that this would be the last wave.

The change comes even as the World Health Organization this week warned against treating the virus as seasonal flu, saying it was too early to make that call. Much of the disease remains unknown, the WHO said. And an increase in cases caused by the Omicron variant is still hitting the continent, while the population of much of the world remains vulnerable due to a widespread lack of vaccination, and other variants are still likely to arise.

Still, proponents of the “learning to live with” approach point out that the latest surge in cases is different from the early days of the virus in several important ways, including a widely vaccinated population in parts of Europe, particularly in West, and a much lower hospitalization rate.

The sentiment is evident in the shift in policies the UK government has adopted since the start of this year, a radical departure from the “war footing” the country’s health service preached in December.

The changes include shorter isolation periods and the elimination of pre-departure testing for people traveling to England – largely because Omicron was already so widespread that testing had a limited effect on its spread.

There have been concrete signs that Britain could be turning a corner. There were 99,652 new cases reported on Friday, a notable drop from the 178,250 cases reported on the same day last week.

“It can’t be an emergency forever,” Graham Medley, professor of infectious disease modeling at the London School of Hygiene and Tropical Medicine, told BBC Radio 4 this week. He added that the end of the pandemic would likely occur in phases rather than appearing as “an active time” when it can be declared over.

Amid this shift, messages to the public have varied, often in confusing ways. The advice may be all over the map, with some politicians declaring the last surge over and others advocating a gradual return to normal – while many experts express caution over all the unknowns and the potential for new variants.

Peter English, a retired consultant in communicable disease control, said for many public health experts and scientists in Britain the debate had moved away from lockdowns towards common sense mitigation measures. Most are now encouraging measures such as mandatory masking in public places and legislation on ventilation standards.

“There had been a row over zero Covid and the attempt to eradicate the virus through restrictions,” he said. “I think we lost that argument. I think by letting it spread to the extent that it has, it will be very, very difficult to put the genie back in the bottle.

From that perspective, he said, “we’re going to have to live with an endemic.” But, he added, “Endemic does not mean not serious”, and he urged caution against the idea of ​​simply “learning to live with it” without mitigation measures in place.

One of the biggest concerns in England has been the intense pressure the virus is placing on the National Health Service, or NHS. But some of the immediate concerns that UK hospitals could be overwhelmed with patients during this latest wave have started to subside.

Matthew Taylor, the head of the NHS Confederation, a membership organization for hospital leaders, said on Wednesday that ‘unless things change unexpectedly, we are close to the national peak of Covid patients in hospital “.

In Spain, a new surveillance system is being created to take effect once the current surge in cases subsides, and the country has also recently eased its isolation rules. But Madrid’s push for Omicron to be treated more like the flu has been criticized by some doctors and professional associations, as well as the European Medicines Agency, who say the virus is still behaving like a pandemic.

In France, infections are still trending upwards, with nearly 300,000 new coronavirus cases reported per day this week, almost six times more than a month ago. But President Emmanuel Macron, who faces a presidential election in April, opted to keep minimal restrictions in place and instead focused on urging the French to get vaccinated.

Mr Macron’s government has rejected accusations that it has backed down from reducing the number of cases, including in schools, which on Thursday faced widespread strikes by teachers concerned about classroom safety.

Mr Véran, the French health minister, who tested positive for coronavirus on Thursday, said authorities were closely monitoring UK data to determine whether France was nearing its own peak.

Germany is several weeks behind some of its European neighbors in dealing with a rise in infections. It reported 80,430 new cases on Tuesday, breaking a record set in November. But independent scientific experts have refrained from advising the government to impose further restrictions despite widespread agreement that the number of infections will continue to rise.

Christian Drosten, the country’s most famous virologist, noted that Germany would most likely eventually switch to treating the virus as endemic.

“Let’s put it this way: we shouldn’t open the door completely,” he said in a podcast interview last week. “But in some areas, we have to open the door a bit to the virus.”

Italy is also grappling with some of the highest daily infection rates since the start of the pandemic. But in recent weeks it has tightened restrictions, making vaccinations compulsory for those aged 50 and over, including requiring a health pass to use public transport.

A spokesman for Italy’s health ministry said the country was “still in a delicate phase” and recent daily increases in cases continued to put pressure on intensive care units. Italian scientists tended to agree that it is too early to declare the situation endemic, although the time had come “to start thinking about the new normal” of coexisting with the virus, said Fabrizio Pregliasco, a virologist at the University of Milan.

This kind of caution is evident among a wide range of healthcare professionals and researchers across Europe, some of whom appealed this week in the British Medical Journal for better coordination in the approach to the pandemic. They argued that there remained an urgent need to “reduce infections to avoid overwhelming health systems and protect public life and the economy”..”

“Even under the most optimistic assumptions,” they wrote, “let Omicron run unlimited risks, potentially devastating consequences.”

In England, hospitalizations are still very high in some areas, especially in the northeast, and illness among healthcare workers continues to strain the system.

England must take a ‘thoughtful and managed approach’ to the pandemic, ‘while considering what our new normal will look like’, said Saffron Cordery, deputy chief executive of NHS Providers, the staff organization of English health.

But, she added, it was clear the country had begun to develop a way of life through several waves of the virus. With much uncertainty still to come, she said it would be wrong to view this moment as an inflection point.

“Rather than being a 100-meter straight line sprint to the Covid finish line,” she explained, “it’s more of a longer-term cross-country race on all kinds of different terrain before you get to that destination.”

Elizabeth Povoledo contributed reporting from Rome, Christopher F. Schuetze from Berlin and Aurelien Breeden from Paris. Raphael Minder also contributed to the report.